Active NPI
Shane Faison
- Massage Therapist
- Raleigh, NC
National Provider Identifier
1669377305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 16412
- Practice address
- 1112 Suffolk Blvd
Raleigh, NC 27603-2734 - Phone
- (404) 919-2464
- NPI assigned
- Oct 12, 2026
- Last updated
- Oct 12, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 16412 | NC | Primary |
Addresses
Primary practice location
1112 Suffolk Blvd
Raleigh, NC 27603-2734
Mailing address
500 Chavis Way
Raleigh, NC 27601-1954
Phone (404) 919-2464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1791763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1791763200000",
"number": "1669377305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CHAVIS WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276011954",
"telephone_number": "404-919-2464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 SUFFOLK BLVD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276032734",
"telephone_number": "404-919-2464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAISON",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-10-12",
"last_updated": "2026-10-12",
"certification_date": "2026-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NC",
"license": "16412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.